The changing food environment and neighborhood prevalence of type 2 diabetes.

In this ecological study, we used longitudinal data to assess if changes in neighborhood food environments were associated with type 2 diabetes mellitus (T2DM) prevalence, controlling for a host of neighborhood characteristics and spatial error correlation. We found that the population-adjusted prevalence of fast-food and pizza restaurants, grocery stores, and full-service restaurants along with changes in their numbers from 1990 to 2010 were associated with 2015 T2DM prevalence. The results suggested that neighborhoods where fast-food restaurants have increased and neighborhoods where full-service restaurants have decreased over time may be especially important targets for educational campaigns or other public health-related T2DM interventions.

Thx 4 the msg: Assessing the Impact of Texting on Student Engagement and Persistence.

As colleges and universities strive to increase persistence and aid students in reaching graduation, they are utilizing alternative communication strategies like text messaging. Behavioral economics researchers suggest personalized, regular nudges can help college students make decisions that positively impact their college career and keep them on track for graduation. The current study presents the results of a randomized field experiment where a text messaging program was implemented in a large college at a public university. The intervention utilized a mixture of automated and personalized text messages from academic advisors and allowed for two-way communication between individual students and their major advisor. Mulitvariate analyses revealed the intervention had no impact on university persistence, but it did increase the odds of persisting in the college to the end of the semester, moving the average, overall college persistence rate from 93 to 95%. Effects were concentrated on underclass students, whose persistence rate moved from 87 to 93% at the college level. Underclass students also showed statistically significant university persistence effects, moving from 90 to 95%. Students who received texts but never engaged with the texting program were significantly less likely to request an advising appointment or to apply to be a student ambassador than were students in the control group. More research is needed to understand what motivates a student to engage with the texting software and to identify what the longer-term consequences of using text messaging to communicate with students might be. Supplementary Information: The online version contains supplementary material available at 10.1007/s11162-022-09678-8.

Incorporation of Information-Seeking Behavior Into Food Insecurity Research.

INTRODUCTION: Limited or uncertain availability of nutritionally adequate and safe foods affects the health of individuals. Because of its association with chronic health conditions, addressing food insecurity may improve health outcomes and decrease health-related costs. This study explores whether and how information seeking as captured by calls made to United Way 2-1-1 can be used to identify food-insecure areas and information deserts-communities with low proportions of residents accessing government food resources but with high rates of 2-1-1 calls for emergency food resources. METHODS: Details regarding calls made to United Way of Salt Lake 2-1-1 for emergency food resources between 2014 and 2018 (n=63,221) were analyzed in 2019. Using GIS methods, areas with the highest number of calls for emergency food resources (hot spots) were identified; multinomial logistic regression was used to identify community-level sociodemographic predictors of food insecurity. RESULTS: Areas with a smaller proportion of the population aged <18 years, more female householders, and more African Americans are associated with higher odds of being food-insecure. CONCLUSIONS: Patterns of information seeking about emergency food resources suggest that, despite statewide access to federal means-tested food programs, significant food needs remain. This novel approach in food insecurity research can help public health officials and health systems address an important social determinant of health by identifying areas vulnerable to food insecurity. In addition, this work may be useful in benchmarking food needs, information seeking, and replicating analyses where similar data are available.

Food Insecurity and the Risk of Obesity, Depression, and Self-Rated Health in Women.

Background/Introduction/Objective: Recent studies have shown that food insecurity is associated with obesity, depression, and other adverse health outcomes although little research has been focused on these relationships in underrepresented cultural and social groups. In this study we elucidate the relationship between food insecurity, community factors, dietary patterns, race/ethnicity and health among underrepresented women. Materials and Methods: The data for this investigation come from a cross-sectional survey of women drawn from five urban Utah communities of color, including African immigrants/refugees, African Americans, Hispanics, American Indians/Alaska Natives, and Pacific Islanders, and women from four rural Utah counties. Multivariate logistic regression was used to assess the relationship between food insecurity and obesity risk, self-reported depression, and self-assessed health. Results: Urban women of color were more likely to report food insecurity than rural non-Hispanic white women. Obesity and depression scores were positively associated with food insecurity. Conclusions: Utah women of color had higher levels of food insecurity than reported in state or national data, highlight an important disparity. Nutritional education initiatives, evaluating food assistance programs, and screenings in clinical settings targeting specific racial/ethnic groups may help address the disparities observed in this study.

Assessing the Likelihood of Having a Regular Health Care Provider among African American and African Immigrant Women.

Objective: Immigrants, especially refugees, face unique barriers to accessing health care relative to native born Americans. In this study, we examined how immigration status, health, barriers to access, and knowledge of the health care system relate to the likelihood of having a regular health care provider. Methods: Using logistic regression and data from a community-based participatory study, we estimated the relative likelihood that an African immigrant woman would have a regular health care provider compared with an African American woman. Results: Immigrant status remains a powerful predictor of whether a woman had a regular health care provider after controlling for covariates. African immigrants were 73% less likely to have a regular health care provider than were otherwise similar African American women. Conclusion: Expanding health care educational efforts for immigrants may be warranted. Future research should examine how cultural beliefs and time in residence influence health care utilization among US immigrants.

The nexus between health and time use among racially and ethnically diverse women.

OBJECTIVES: Ethnic and racial health disparities have been well-documented in the scholarly literature. In recent years, evidence about time spent in physical (in)activity and its relationship to physical and mental health has also emerged. This study assesses if observed ethnic/racial health differences were associated with differences in time use. DESIGN: Our analyses utilized baseline data from 510 Utah women who enrolled in one of two community-based, participatory research intervention studies between 2012 and 2015. The distinct racial/ethnic groups included African immigrants, African Americans, Latinas, Native Hawaiians/Pacific Islanders, American Indians/Alaskan Natives, and rural White, Non-Latina women. In the baseline survey, respondents reported the typical time they spent in paid employment, television/movie viewing, physical activity, food preparation/clean-up, and sleep. Cluster analysis was used to identify seven distinct patterns of time use within these five activities. We related these time use patterns along with race/ethnicity, socio-demographics, and other potentially contributing health-related factors (e.g. smoking status) to two health outcomes: (1) self-reported health status, and (2) depression. RESULTS: Our time use clusters revealed heterogeneity by racial/ethnic groups, suggesting that some of the health effects that may have been previously ascribed to group membership should instead be attributed to (un)healthy patterns of time use. In particular, spending too much time in sedentary activities such as watching television/movies and too little time sleeping both linked to poor physical and mental health, independently of racial/ethnic group membership. CONCLUSIONS: Researchers and policy makers designing culturally sensitive physical activity health-related interventions should consider patterns of time use that are associated with poor health. Programs designed to improve sleep time and reduce sedentary television-viewing time may be as important as interventions designed to increase physical activity time. These broader patterns of time use mediated the relationships between race/ethnicity and physical and mental health for the women in our study.

The joint effects of family risk of obesity and neighborhood environment on obesity among women.

Obesity is a significant health problem in the United States that has encouraged a search for modifiable risk factors, such as walkable neighborhood designs. Prior research has shown linkages between a family history of obesity (i.e., due to either genetic or non-genetic factors) and an individual's risk of elevated body mass index (BMI). Yet, we know little about the possible interactions between neighborhood walkability and family susceptibility to unhealthy BMI in predicting individual BMI. This paper addresses this important research gap using a sample of 9918 women, derived from vital and administrative data in the Utah Population Database. We use a novel indicator of familial risk (a summary measure of siblings' BMI) and a neighborhood walkability score to capture familial susceptibility and environmental exposures, respectively. The analysis focuses on distinct risk combinations of familial susceptibility and neighborhood walkability. Compared with the "best" combination of lean family BMI history and more walkable neighborhoods, women in all of the other three family weight history/neighborhood categories show greater risks of obesity. Our results also indicate that the neighborhood environment has a strong association with individual obesity among women with higher family risk of obesity but that the association between neighborhood environment and individual obesity is even stronger for women with a lower family risk of obesity.

Outcomes From a Hearing-Targeted Cytomegalovirus Screening Program.

BACKGROUND AND OBJECTIVES: Cytomegalovirus (CMV) is the most common congenital infection and nongenetic cause of congenital sensorineural hearing loss in the United States. Utah was the first state to pass legislation mandating CMV screening for newborns who fail newborn hearing screening (NBHS). The study objective was to present outcomes of hearing-targeted CMV screening and determine factors predicting CMV screening. METHODS: We used Utah Department of Health HiTrack and Vital Records databases to examine CMV screening from 509 infants who failed NBHS in the 24 months after implementation of the Utah legislation. Multivariate logistic regression analyses were conducted to identify predictors of compliance with CMV screening and diagnostic hearing evaluation. RESULTS: Sixty-two percent of infants who never passed hearing screening underwent CMV screening. Fourteen of 234 infants tested within 21 days were CMV positive; 6 (42.9%) had hearing loss. Seventy-seven percent of eligible infants completed a diagnostic hearing evaluation within 90 days of birth. Compliance with CMV screening was associated with sociodemographic factors, time since the law was enacted, and NBHS protocol. Infants born after the legislation showed greater odds of achieving timely diagnostic hearing evaluation than infants born before the law. CONCLUSIONS: Incorporating CMV screening into an established NBHS program is a viable option for the identification of CMV in infants failing NBHS. The addition of CMV testing can help a NBHS program attain timely audiological diagnostics within 90 days, an important early hearing detection and intervention milestone.

Planning Ahead or Living a Day at a Time? A Family History of AD and Retirement Planning.

BACKGROUND: We assess whether a family history of Alzheimer's disease (AD) is associated with the odds that healthy family members' engage in retirement planning activities. METHODS: This is a cross-sectional study utilizing individual-level data from the Utah Population Database that have been linked to Medicare records and to responses from a retirement planning survey. Engagement in 3 retirement planning activities was estimated as a function of the number of parents and grandparents diagnosed with AD along with a set of fundamental socioeconomic and demographic covariates. RESULTS: Adults who had a parent with AD were 86% more likely to have seen a professional financial advisor and 40% less likely to plan to retire before age 65. CONCLUSIONS: Caregiving costs and/or knowledge of the familial risk of developing AD may provide adult children with a forewarning of their own future financial needs that, in turn, motivates them to engage in retirement planning.

Cost-benefit analysis of targeted hearing directed early testing for congenital cytomegalovirus infection.

OBJECTIVES: In this study, we estimate an ex ante cost-benefit analysis of a Utah law directed at improving early cytomegalovirus (CMV) detection. STUDY DESIGN: We use a differential cost of treatment analysis for publicly insured CMV-infected infants detected by a statewide hearing-directed CMV screening program. METHODS: Utah government administrative data and multi-hospital accounting data are used to estimate and compare costs and benefits for the Utah infant population. RESULTS: If antiviral treatment succeeds in mitigating hearing loss for one infant per year, the public savings will offset the public costs incurred by screening and treatment. If antiviral treatment is not successful, the program represents a net cost, but may still have non-monetary benefits such as accelerated achievement of diagnostic milestones. CONCLUSIONS: The CMV education and treatment program costs are modest and show potential for significant cost savings.

Family Health Histories and Their Impact on Retirement Confidence.

OBJECTIVE: Retirement confidence is a key social barometer. In this article, we examine how personal and parental health histories relate to working-age adults' feelings of optimism or pessimism about their overall retirement prospects. METHOD: This study links survey data on retirement planning with information on respondents' own health histories and those of their parents. The multivariate models control for the respondents' socio-demographic and economic characteristics along with past retirement planning activities when estimating the relationships between family health histories and retirement confidence. RESULTS: Retirement confidence is inversely related to parental history of cancer and cardiovascular disease but not to personal health history. In contrast, retirement confidence is positively associated with both parents being deceased. DISCUSSION: As members of the public become increasingly aware of how genetics and other family factors affect intergenerational transmission of chronic diseases, it is likely that the link between family health histories and retirement confidence will intensify.

Putting it off: family breast cancer history and women's retirement planning.

OBJECTIVE: Cancer diagnoses have significant consequences that extend beyond the individual to family members. Our research builds on prior research by examining how a family history of breast cancer is related to women's retirement preparations. METHODS: Taking guidance from the stress process model, we generate and test hypotheses using multivariate logistic regression and unique data on retirement planning and familial cancer histories for 467 women. We supplement this analysis with the qualitative findings from two focus groups. RESULTS: We find consistent evidence that women with a mother and/or sister who had a breast cancer diagnosis are significantly less likely to engage in retirement preparation activities than otherwise similar women with no family history. The same effect is not observed when other first-degree relatives have different cancer diagnoses. The face validity of these quantitative findings is confirmed by the focus group analysis. CONCLUSIONS: Our research suggests that the stressors experienced by close female relatives of women who have had breast cancer may lead to behaviors and attitudes that have consequences for their post-retirement quality of life.

Geographic scale matters in detecting the relationship between neighbourhood food environments and obesity risk: an analysis of driver license records in Salt Lake County, Utah.

OBJECTIVES: Empirical studies of the association between neighbourhood food environments and individual obesity risk have found mixed results. One possible cause of these mixed findings is the variation in neighbourhood geographic scale used. The purpose of this paper was to examine how various neighbourhood geographic scales affected the estimated relationship between food environments and obesity risk. DESIGN: Cross-sectional secondary data analysis. SETTING: Salt Lake County, Utah, USA. PARTICIPANTS: 403,305 Salt Lake County adults 25-64 in the Utah driver license database between 1995 and 2008. ANALYSIS: Utah driver license data were geo-linked to 2000 US Census data and Dun & Bradstreet business data. Food outlets were classified into the categories of large grocery stores, convenience stores, limited-service restaurants and full-service restaurants, and measured at four neighbourhood geographic scales: Census block group, Census tract, ZIP code and a 1 km buffer around the resident's house. These measures were regressed on individual obesity status using multilevel random intercept regressions. OUTCOME: Obesity. RESULTS: Food environment was important for obesity but the scale of the relevant neighbourhood differs for different type of outlets: large grocery stores were not significant at all four geographic scales, limited-service restaurants at the medium-to-large scale (Census tract or larger) and convenience stores and full-service restaurants at the smallest scale (Census tract or smaller). CONCLUSIONS: The choice of neighbourhood geographic scale can affect the estimated significance of the association between neighbourhood food environments and individual obesity risk. However, variations in geographic scale alone do not explain the mixed findings in the literature. If researchers are constrained to use one geographic scale with multiple categories of food outlets, using Census tract or 1 km buffer as the neighbourhood geographic unit is likely to allow researchers to detect most significant relationships.

Active transportation: do current traffic safety policies protect non-motorists?

OBJECTIVE: This study investigated the impact that state traffic safety regulations have on non-motorist fatality rates. METHODS: Data obtained from the National Highway Traffic Safety Administration (NHTSA), the Federal Highway Administration (FHWA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) were analyzed through a pooled time series cross-sectional model using fixed effects regression for all 50 states from 1999 to 2009. Two dependent variables were used in separate models measuring annual state non-motorist fatalities per million population, and the natural log of state non-motorist fatalities. Independent variables measuring traffic policies included state expenditures for highway law enforcement and safety per capita; driver cell phone use regulations; graduated driver license regulations; driver blood alcohol concentration regulations; bike helmet regulations; and seat belt regulations. Other control variables included percent of all vehicle miles driven that are urban and mean per capita alcohol consumption per year. RESULTS: Non-motorist traffic safety was positively impacted by state highway law enforcement and safety expenditures per capita, with a decrease in non-motorist fatalities occurring with increased spending. Per capita consumption of alcohol also influenced non-motorist fatalities, with higher non-motorist fatalities occurring with higher per capita consumption of alcohol. Other traffic safety covariates did not appear to have a significant impact on non-motorist fatality rates in the models. CONCLUSION: Our research suggests that increased expenditures on state highway and traffic safety and the initiation/expansion of programs targeted at curbing both driver and non-motorist intoxication are a starting point for the implementation of traffic safety policies that reduce risks for non-motorists.

Does Daylight Savings Time encourage physical activity?

BACKGROUND: Extending Daylight Savings Time (DST) has been identified as a policy intervention that may encourage physical activity. However, there has been little research on the question of if DST encourages adults to be more physically active. METHODS: Data from residents of Arizona, Colorado, New Mexico, and Utah ages 18-64 who participated in the 2003-2009 American Time Use Survey are used to assess whether DST is associated with increased time spent in moderate-to-vigorous physical activity (MVPA). The analysis capitalizes on the natural experiment created because Arizona does not observe DST. RESULTS: Both bivariate and multivariate analyses indicate that shifting 1 hour of daylight from morning to evening does not impact MVPA of Americans living in the southwest. CONCLUSIONS: While DST may affect the choices people make about the timing and location of their sports/recreational activities, the potential for DST to serve as a broad-based intervention that encourages greater sports/recreation participation is not supported by this analysis. Whether this null effect would persist in other climate situations is an open question.

Family, frailty, and fatal futures? Own-health and family-health predictors of subjective life expectancy.

Subjective life expectancy is a powerful predictor of a variety of health and economic behaviors. This research expands upon the life expectancy literature by examining the influence of familial health histories. Using a genetic/environmental model, we hypothesize that individuals' assessments of their life expectancies will be linked to the health of first-degree and second-degree relatives, with same-sex relatives' health exercising a stronger effect than that of opposite-sex relatives. Multivariate analyses based on data from a 2009 survey merged with familial health records (N = 1,019) confirm that the health experiences of same-sex, first-degree relatives are linked to respondents' subjective life expectancy. The relationship between the health experiences of second-degree relatives and subjective life expectancy is much less pronounced. These findings have the potential not only to inform our understanding of health behaviors but also to encourage communication between patients and health professionals aimed at promoting preventative behaviors.

Harvesting more than vegetables: the potential weight control benefits of community gardening.

OBJECTIVES: We examined the association of participation in community gardening with healthy body weight. METHODS: We examined body mass index (BMI) data from 198 community gardening participants in Salt Lake City, Utah, in relationship to BMI data for 3 comparison groups: neighbors, siblings, and spouses. In comparisons, we adjusted for gender, age, and the year of the BMI measurement. RESULTS: Both women and men community gardeners had significantly lower BMIs than did their neighbors who were not in the community gardening program. The estimated BMI reductions in the multivariate analyses were -1.84 for women and -2.36 for men. We also observed significantly lower BMIs for women community gardeners compared with their sisters (-1.88) and men community gardeners compared with their brothers (-1.33). Community gardeners also had lower odds of being overweight or obese than did their otherwise similar neighbors. CONCLUSIONS: The health benefits of community gardening may go beyond enhancing the gardeners' intake of fruits and vegetables. Community gardens may be a valuable element of land use diversity that merits consideration by public health officials who want to identify neighborhood features that promote health.

Moderate to vigorous physical activity and weight outcomes: does every minute count?

PURPOSE: The purpose of this study was to test if moderate to vigorous physical activity (MVPA) in less than the recommended ≥10-minute bouts related to weight outcomes. DESIGN: Secondary data analysis. SETTING: Random sample from the U.S. civilian noninstitutionalized population included in the National Health and Nutrition Examination Survey (NHANES). PARTICIPANTS: A total of 4511 adults aged 18 to 64 years from the 2003-2006 NHANES. METHOD: Clinically measured body mass index (BMI) and overweight/obese status were regressed on accelerometer measures of minutes per day in higher-intensity long bouts (≥10 minutes, ≥2020 accelerometer counts per minute [cpm]), higher-intensity short bouts (<10 minutes, ≥2020 cpm), lower-intensity long bouts (≥10 minutes, 760-2019 cpm), and lower-intensity short bouts (<10 minutes, 760-2019 cpm). Socioeconomic and demographic characteristics were controlled. RESULTS: Both higher-intensity short bouts and long bouts of PA related to lower BMI and risk of overweight/obesity. Neither lower-intensity short bouts nor long bouts related to BMI or risk of overweight/obesity. CONCLUSION: The current ≥10-minute MVPA bouts guideline was based on health benefits other than weight outcomes. Our findings showed that for weight gain prevention, accumulated higher-intensity PA bouts of <10 minutes are highly beneficial, supporting the public health promotion message that "every minute counts."

Re-visiting the relationship between neighbourhood environment and BMI: an instrumental variables approach to correcting for residential selection bias.

BACKGROUND: A burgeoning literature links attributes of neighbourhoods' built environments to residents' physical activity, food and transportation choices, weight, and/or obesity risk. In cross-sectional studies, non-random residential selection impedes researchers' ability to conclude that neighbourhood environments cause these outcomes. METHODS: Cross-sectional data for the current study are based on 14,689 non-Hispanic white women living in Salt Lake County, Utah, USA. Instrumental variables techniques are used to adjust for the possibility that neighbourhoods may affect weight but heavier or lighter women may also choose to live in certain neighbourhoods. All analyses control for the average BMI of siblings and thus familial predisposition for overweight/obesity, which is often an omitted variable in past studies. RESULTS: We find that cross-sectional analyses relating neighbourhood characteristics to BMI understate the strength of the relationship if they do not make statistical adjustments for the decision to live in a walkable neighbourhood. Standard cross-sectional estimation reveals no significant relationship between neighbourhood walkability and BMI. However, the instrumental variables estimates reveal statistically significant effects. CONCLUSIONS: We find evidence that residential selection leads to an understatement of the causal effects of neighbourhood walkability features on BMI. Although caution should be used in generalizing from research done with one demographic group in a single locale, our findings support the contention that public policies designed to alter neighbourhood walkability may moderately affect the BMI of large numbers of individuals.

Neighborhood design for walking and biking: physical activity and body mass index.

BACKGROUND: Neighborhood designs often relate to physical activity and to BMI. PURPOSE: Does neighborhood walkability/bikeability relate to BMI and obesity risk and does moderate-to-vigorous physical activity (MVPA) account for some of the relationship? METHODS: Census 2000 provided walkability/bikeability measures-block group proportions of workers who walk or bike to work, housing age, and population density-and National Health and Nutrition Examination Study (NHANES 2003-2006) provided MVPA accelerometer measures. Regression analyses (2011-2012) adjusted for geographic clustering and multiple control variables. RESULTS: Greater density and older housing were associated with lower male BMI in bivariate analyses, but there were no density and housing age effects in multivariate models. For women, greater proportions of neighborhood workers who walk to work (M=0.02) and more MVPA was associated with lower BMI and lower obesity risk. For men, greater proportions of workers who bike to work (M=0.004) and more MVPA was associated with lower BMI and obesity risk. For both effects, MVPA partially mediated the relationships between walkability/bikeability and BMI. If such associations are causal, doubling walk and bike-to-work proportions (to 0.04 and 0.008) would have -0.3 and -0.33 effects on the average BMIs of adult women and men living in the neighborhood. This equates to 1.5 pounds for a 64-inch-tall woman and 2.3 pounds for a 69-inch-tall man. CONCLUSIONS: Although walking/biking to work is rare in the U.S., greater proportions of such workers in neighborhoods relate to lower weight and higher MVPA. Bikeability merits greater attention as a modifiable activity-friendliness factor, particularly for men.